Attachment Prototype Research Articles

Attachment performance analysis and experimental study of lunar rock bionic attachment device based on DEM-MBD

Lunar rock sampling is an important means of studying the evolutionary history of planets. However, facing the special microgravity environment of the Moon, general rock sampling drills cannot provide the torque and pressure required for the mission. Therefore, it is of great significance to study the sampling drill with attachment function. In this study, the claw spines of insects were simulated, and a biomimetic spine laminated structure with flexible connections was designed. The working principle of attachment and detachment was analyzed using a rod model with elastic characteristics. The process of biomimetic spines attaching to rough surfaces was simulated using the coupling method of multi-body dynamics and discrete element analysis (MBD-DEM). The mechanical properties of bionic claws during attachment were analyzed. Mechanical experiments were conducted on biomimetic spines attached to volcanic rock. The experiment results for single and multiple spines were compared with the simulation results, verifying the accuracy and reliability of the simulation model. Finally, A bionic attachment prototype was designed and tested for performance. The attachment device was integrated into a sampling drill and drilling experiments were conducted. This article provides important reference for the optimization of biomimetic spine structures, along with adding value to the design of attachment equipment.

Idiographic assessment of attachment relationships: Construction and validation of scales for use in narrative psychotherapy

In this study the focus was on the development and validation of scales that can be used in an attachment-based narrative form of psychotherapy/counseling. One hundred and six participants completed an online survey, in which they were asked to select one significant troublesome relationship (past or present), to describe the nature of this relationship in a couple of sentences and to characterize the relationship by means of the list of 49 attachment items. By employing exploratory and confirmatory factor analysis (N = 106), a six-factor model emerged covering four classical attachment prototypes: (I) security; (II) anxiety (preoccupation with relationships, fear of rejection); (III) dismissive avoidance (i.e., defensive separation/denial of attachment need; and (IV) fearful avoidance (avoidance/alienation, threat). In two validation studies, the interpersonal and affective meaning of these scales were examined by using instruments that accentuate agentic and communal interpersonal orientations in human contact. In a subsequent qualitative study, we used a cluster-based classification into attachment groups for the exhaustive screening of the content of (a selection of) 40 texts of 40 persons. This hermeneutic approach disclosed characteristic themes for each of the secure, preoccupied, dismissive-avoidant and fearful-avoidant prototypes which are discussed in detail. In narrative psychotherapy a thematic overview according to the attachment typology may be helpful in fine-tuning the therapeutic process, in that it may increase a client’s awareness of attachment issues and associated (dysfunctional) emotional reactions.

Factor Structure and Convergent Validity of the Short Version of the Bielefeld Partnership Expectations Questionnaire in Patients With Anxiety Disorder and Healthy Controls.

The short version of the Bielefeld Partnership Expectations Questionnaire (BPEQ-12) assesses the partner-related attachment dimensions fear of rejection, readiness for self-disclosure, and conscious need for care. The presented study investigated the factor structure in two samples and evaluated the convergent validity of scales. The sample included N = 175 patients with panic disorder and/or agoraphobia and N = 143 healthy controls. Besides, the BPEQ, the Experiences in Close Relationships Questionnaire (ECR), and the Brief Symptom Inventory (BSI) were assessed as well, and the Adult Attachment Prototype Rating (AAPR) was conducted. A confirmatory factor analysis of the three factor model (using a WLSMV estimator) revealed an acceptable model fit for the entire sample, patients and controls in terms of low RMSEA and SRMR (< 0.08) and high CFI and TLI (> 0.95). We found metric, scalar, and strict measurement invariance for the presence of anxiety disorder (ΔCFI ≤ –0.01 and ΔRMSEA ≥ 0.01). However, only for fear of rejection and readiness for self-disclosure the reliability was acceptable (Cronbach’s α > 0.7), and convergent validity in terms of large correlations (r > 0.7) with the ECR scales was found in both samples. The scale conscious need for care had a questionable reliability (Cronbach’s α > 0.6) and correlated only slightly with ECR-R scales. We conclude that fear of rejection and readiness for self-disclosure of the BPEQ-12 are reliable and valid scales for measuring partner-related attachment in healthy and clinical samples.

An empirical test of prototype and revisionist models of attachment stability and change from middle childhood to adolescence: A 6-year longitudinal study.

We examined the prototype v. revisionist models of attachment stability with a five-wave, 6-year, longitudinal study of attachment security from middle childhood to adolescence in a White Western European sample (N=157; Wave 1Mage =10.91, SD=0.87; 52% female). Attachment was assessed using both questionnaire (Experiences in Close Relationships) and narrative-based measures (Attachment Script Assessment). In addition, a set of potential moderators of prototype-like stability were examined. Results indicated that data from both attachment assessments best fit the prototype model. Moderator analyses indicated that male sex significantly undermined the influence of an attachment prototype and parent-child conflict and parental divorce enhanced the influence of an attachment prototype on stability.

Technical and clinical study of x-ray-based surface echo probe tracking using an attached fiducial apparatus.

Several types of structural heart intervention (SHI) use information from multiple imaging modalities to complete an interventional task. For example, in transcatheter aortic valve replacement (TAVR), placement and deployment of a bioprosthetic aortic valve in the aorta is primarily guided by x-ray fluoroscopy (XRF), and echocardiography provides visualization of cardiac anatomy and blood flow. However, simultaneous interpretation of independent x-ray and echo displays remains a challenge for the interventionalist. The purpose of this work was to develop a novel echo/x-ray co-registration solution in which volumetric transthoracic echo (TTE) is transformed to the x-ray coordinate system by tracking the three-dimensional (3D) pose of a probe fiducial attachment from its appearance in two-dimensional (2D) x-ray images. A fiducial attachment for a commercial TTE probe consisting of rings of high-contrast ball bearings was designed and fabricated. The 3D pose (position and orientation) of the fiducial attachment is estimated from a 2D x-ray image using an algorithm in which a virtual point cloud model of the attachment is iteratively rotated, translated, and forward-projected onto the image until the average sum-of-squares of grayscale values at the projected points is minimized. Fiducial registration error (FRE) and target registration error (TRE) of this approach were evaluated in phantom studies using TAVR-relevant gantry orientations and four standard acoustic windows for the TTE probe. A patient study was conducted to assess the clinical suitability of the fiducial attachment prototype during TTE imaging of patients undergoing SHI. TTE image quality for the task of guiding a transcatheter procedure was evaluated in a reviewer study. The 3D FRE ranged from 0.32±0.03mm (mean±SD) to 1.31±0.05mm, depending on C-arm orientation and probe acoustic window. The 3D TRE ranged from 1.06±0.03mm to 2.42±0.06mm. Fiducial pose estimation was stable when >75% of the fiducial markers were visible in the x-ray image. A panel of reviewers graded the presentation of heart valves in TTE images from 48 SHI patients. While valve presentation did not differ significantly between acoustic windows (P>0.05), the mitral valve did achieve a significantly higher image quality compared to the aortic and tricuspid valves (P<0.001). Overall, reviewers perceived sufficient image quality in 76.5% of images of the mitral valve, 54.9% of images of the aortic valve, and 48.6% of images of the tricuspid valve. Fiducial-based tracking of a commercial TTE probe is compatible with clinical SHI workflows and yields 3D target registration error of less than 2.5mm for a variety of x-ray gantry geometries and echo probe acoustic windows. Although TTE image quality with respect to target valve anatomy was sufficient for the majority of cases examined, prescreening of patients for sufficient TTE quality would be helpful.

Differential effects of adult attachment in cognitive‐behavioural and psychodynamic therapy in social anxiety disorder: A comparison between a self‐rating and an observer rating

Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.

M113. THE RELATIONSHIP BETWEEN ATTACHMENT STYLES AND CLINICAL PRESENTATION IN EARLY PSYCHOSIS PATIENTS

BackgroundResearch in both clinical and early psychosis samples is increasingly indicating that insecure attachment styles impact on psychosis symptom expression. Moreover, empirical support has been found for the assumption that specific types of insecure attachment predispose individuals to develop different symptom profiles. This study aimed to increase our understanding of the relevance of attachment styles in an early psychosis sample. To this end, we first examined the relationship of attachment styles with the severity of positive, negative and general symptom dimensions. Secondly, associations between attachment styles and specific positive psychotic symptoms were explored.MethodsA total of 96 (60 At-Risk Mental State and 36 First Episode Psychosis) patients participated in the study. Patients’ attachment style was assessed by the Psychosis Attachment Measure (PAM) and the Relationship Questionnaire (RQ). The PAM was used to evaluate attachment dimensions (i.e., anxiety and avoidance), whereas RQ was employed to classify participants into an attachment prototypes (i.e., secure, fearful, preoccupied or dismissive). In addition, patients were administered the Positive and Negative Syndromes Scale. Correlation analyses examined the associations of patients’ attachment dimensions and patients’ attachment prototypes with symptom dimensions (positive, negative and general psychopathology) and specific positive psychotic symptoms (delusions, conceptual disorganization, hallucinations, excitement, grandiosity, paranoia and hostility).ResultsPatients’ attachment anxiety was associated with positive symptoms and general psychopathology, whereas no associations were found between attachment avoidance and symptom dimensions. Moreover, only attachment anxiety was related with specific positive symptoms, such as hallucinations and paranoia. Regarding the associations between attachment prototypes and symptom dimensions, only secure attachment was significantly related to decreased levels of general symptoms. Besides, secure attachment was associated with decreased levels of paranoia, whereas fearful attachment was related with increased levels of paranoid symptoms. No significant relationships were observed between dismissing and preoccupied attachment with specific positive symptoms.DiscussionThese findings highlight the potential role of secure attachment as a protective factor against poor clinical outcomes and are consistent with previous studies indicating that secure attachment confers a form of resilience for psychopathology. In contrast, attachment anxiety and fearful attachment might represent risk factors for general and positive symptoms. The fact that neither attachment dimensions nor attachment prototypes were associated with the negative symptom dimension seems to confirm previous findings and might suggest that the association of attachment with psychotic symptoms is more robust for the positive dimension. These findings highlight the need of tailoring interventions to patients’ attachment needs. This would include assessing patients’ attachment patterns, as the specific subtypes of insecure attachment style should provide guidance in the context of psychological formulation and treatment planning with early psychosis patients.

Therapist Evaluation of Client Adaptive Interpersonal Vulnerability: Relationship to Attachment Style.

The clinician-rated Adaptive Interpersonal Vulnerability Scale (AIVS) was developed from items of the Shedler-Westen Assessment Procedure (SWAP; Westen & Shelder, 2007; Westen, Waller, Shedler, & Blagov, 2014). Convergent validity of the AIVS was examined with self-report attachment style measures: Relationship Questionnaire (RQ; Bartholomew & Horowitz, 1991) and Experiences in Close Relationships Questionnaire-Revised (ECR-R; Fraley, Waller, & Brennan, 2000). Fifty-nine patients completed the RQ and ECR-R before beginning psychotherapy. Clinicians rated patients on the SWAP after six sessions. The AIVS was negatively related to the RQ Fearful/Avoidance scale, the ECR-R attachment anxiety scale, and the ECR-R attachment avoidance scale and positively related to the RQ Secure Attachment scale, although not significant. Findings provide initial supposrt for the AIVS as a therapist-rated measure associated with lower client-reported levels of the fearful/avoidant attachment prototype, attachment anxiety, and attachment avoidance. Implications and suggestions for future research on the AIVS and clinical work are discussed.

Is therapist evaluation of Social Anxiety/Avoidance traits associated with patient-reported attachment style?

The Social Anxiety/Avoidance Scale was recently added to the Shedler Westen Assessment Procedure (SWAP), and requires independent validation. This study used data drawn from a larger ongoing project in order to retrospectively examine its convergent validity with two self-report attachment measures: Relationship Questionnaire (RQ) and Experiences in Close Relationships Questionnaire-Revised (ECR-R). Fifty-two patients completed the RQ and the ECR-R before beginning psychotherapy treatment. Clinicians rated the patients on the SWAP after six sessions. The SWAP Social Anxiety/Avoidance Scale (SWAP-SAAS) was negatively related to the RQ secure attachment prototype scale and positively related to the ECR-R attachment anxiety scale. Our findings provide initial support for the use of the SWAP-SAAS as a therapist-rated measure associated with lower patient-reported levels of fit with a secure attachment prototype and with higher patient-reported levels of attachment anxiety. Implications and suggestions for future research on the SWAP-SAAS, as well as for clinical work with socially anxious and avoidant patients, are discussed.

Adult attachment internal working model of self and other in Chinese culture: Measured by the Attachment Style Questionnaire — Short Form (ASQ-SF) by confirmatory factor analysis (CFA) and item response theory (IRT)

According to the study by Griffin and Bartholomew (1994), in Western context, the adult attachment internal working model was found to consist two components: (i) the self model, and (ii) the other model. The current study was grounded on Griffin's and Bartholomew's study to investigate the adult internal working model of self and other in Chinese context. Moreover, by confirmatory factor analysis (CFA) and item response theory (IRT), the Attachment Style Questionnaire (ASQ; Van Oudenhoven et al., 2001) was condensed to become the ASQ — Short Form. In addition, the four attachment prototypes, namely, secure, fearful-avoidant, preoccupied and dismissing as well as the adult internal working model of self and other were found to be present in Chinese culture.

Attachment style and significant relationships in severe mental illness adults

Introduction The way in which we establish our relationships, our attachment styles, it is crucial for a more active and fulfilling social life, as well as to achieve greater personal satisfaction and quality of life. Attachment style, learned during the early stages of life, regarding to parental figures or other figures, seems to have some relation to the quality of relationships that we will have later in adulthood. Objectives/aims Describe attachment styles established with people in a sample of patients with severe mental illness (SMI). Methods Implementation of an ad hoc questionnaire based on the interview adult attachment prototypes (EPAA), which explores attachment relationships with the father, and others. A sample of 24 participants diagnosed with SMI was explored. Results After examination of past relationships, we found more extreme scores in significant others above mother and father. Especially in dimensions that would be closer to a secure attachment. The analysis of the actual relationship again identified the significant others as establishing closer interactions to secure attachment. The significant others were composed mainly by grandfathers and brothers in the past, and brothers and friends in the present. Conclusions It is important to note that, for our sample, parents appear less associated to a secure attachment, highlighting this the importance of intervening with families to develop healthier relationships. On the other hand, we found fluctuations in time of others, which might suggest the need to intervene on these issues from a psychosocial and historical perspective.

Comparison of self-reported attachment in young adults from Spain and the United States.

Previous studies have provided mixed evidence in support of the structure of Bartholomew's attachment framework. The current study examined the comparability of the correlations among the attachment prototypes as well as the underlying factor structure of the Relationship Questionnaire in independent samples of Spanish and American young adults. Participants were 547 students from the Universitat Autònoma de Barcelona and 1425 from the University of North Carolina at Greensboro who completed the Relationship Questionnaire. Secure attachment was negatively correlated with fearful attachment, as was preoccupied attachment with dismissing attachment. The secure-fearful association in the American sample represented a medium effect size, whereas the remaining correlations represented small effect sizes. Except for the secure-fearful association, the correlations among prototypes were comparable in magnitude across samples. A principal components analysis yielded two factors that explained similar amounts of variance in the two samples. The pattern of loadings was relatively comparable in both samples; however, it was not entirely consistent with the theoretical model. The findings provided only partial support to the structure of the theoretical framework invoked. We discuss an alternative interpretation of the two factors, as well as further measurement considerations and directions for future research.

Association between attachment prototypes and schizotypy dimensions in two independent non-clinical samples of Spanish and American young adults

Attachment theory offers a powerful theoretical framework for elucidating the developmental pathway through which childhood interpersonal trauma confers vulnerability to psychosis. In the present study, the association between attachment and schizotypy was explored in two independent non-clinical samples of Spanish (n=547) and American (n=1425) young adults. Participants completed the Relationship Questionnaire and the Wisconsin Schizotypy Scales. Following attachment theory and cognitive accounts of psychosis, it was hypothesized that preoccupied attachment would be associated with positive schizotypy, dismissing attachment with negative schizotypy, and fearful attachment with both schizotypy dimensions. Results confirmed these predictions, thus supporting the theoretical frameworks invoked. Also, the associations found in these non-clinical samples are consistent with those in clinical psychosis, supporting the continuum model of schizotypy and schizophrenia. Finally, there was cross-cultural consistency of these associations. Overall, the findings support the application of attachment theory for furthering our understanding of whether different insecure styles, characterized by different self and other representations and affect regulation strategies, play a role in the pathways to positive and negative symptoms.

Associations between adult attachment characteristics, medical burden, and life satisfaction among older primary care patients.

We investigated whether attachment security, measured by the Adult Attachment Prototype Rating (AAPR), was correlated with life satisfaction, independent of sociodemographic characteristics, medical burden, and age-related coping strategies in a sample of 81 patients (69-73 years) recruited from the register of a general primary care practice. Furthermore, we examined whether patients classified as AAPR-secure reported better adjustment to medical burden in terms of higher life satisfaction than did insecure patients. Attachment security was independently related to life satisfaction. Moreover, the association between medical burden and lower life satisfaction was significantly stronger for insecure than for secure participants. Our findings indicate that interventions to improve attachment security or coping processes related to attachment could help older adults retain life satisfaction.

A Prototype-Based Model of Adult Attachment for Clinicians

Models of adult attachment have proven to be useful for understanding illness behavior, stress responses, susceptibility to disease processes, and psychotherapeutic approaches to difficult patients. Two methods of assessing patterns of attachment, using self-report instruments and using techniques such as the Adult Attachment Interview (AAI), are only weakly related and each has drawbacks for clinical use. We have previously assessed commonalities and differences in the descriptions of attachment patterns that emerge from these schools and synthesized them in empirically based attachment prototypes. In this companion article, we describe a prototype-based model of attachment. This model defines dimensions of attachment anxiety and attachment avoidance as composites of particular aspects of internal working models of self and other, behavior in current close relationships, patterns of expression of affect, and narrative coherence. The model emphasizes the clinical importance of the severity of attachment insecurity, defined as a dimension which incorporates problems in the previously listed domains of attachment as well as deficits in mentalizing, self-agency, and resolution of trauma. The model locates the central tendencies of prototypic ("textbook") descriptions of four patterns of attachment (secure, dismissing, preoccupied, and fearful/disorganized) while avoiding definitions of the boundaries between categories of attachment. We compare the prototype-based model to the two most prominent current models of attachment, the 4-category, 2-dimension model derived from self-report methods of assessment and categories of "attachment states of mind" derived from the Adult Attachment Interview. Finally, we discuss limitations of the prototype-based model and areas requiring further research.

Attachment style predicts 6‐month improvement in psychoticism in persons with at‐risk mental states for psychosis

Insecure attachment may influence vulnerability to and outcome of psychotic symptomatology. The present study examined whether attachment style predicted symptoms and functioning of at-risk mental state (ARMS) patients after 6 months of psychosocial intervention, over and above the effects of initial clinical severity and premorbid social adjustment (PSA). Symptoms and functioning were assessed at baseline and 6 months later in 31 ARMS patients (mean age = 15.7). No patient received antipsychotic medication, but all engaged in intense psychosocial needs-adapted treatment. Clinicians (unaware of the aims of the study) rated attachment, PSA, symptoms, and functioning. Attachment was not related to baseline clinical severity. However, improvement in psychoticism was predicted by attachment (in particular by secure, preoccupied and dismissing) beyond the effects of baseline clinical severity and PSA. Secure attachment also predicted improvements in disorganization and functioning. Poor PSA predicted less improvement in disorganization and negative symptoms but did not impact psychoticism. The three attachment prototypes that predicted improvement in psychoticism (secure, preoccupied and dismissing) share the existence of at least one positive psychological model (either about self or about others). It may be that the psychosocial intervention helped ARMS patients to disconfirm negative models and/or reinforce positive ones. Patients' attachment styles were not related to baseline clinical severity but impacted improvement of positive symptoms. These findings appear consistent with evidence that impaired self-esteem and dysfunctional self and others schemas constitute risk factors for reality distortion.

Attachment style contributes to the outcome of a multimodal lifestyle intervention

Background & AimsThe long-term success of life-style interventions in the treatment of obesity is limited. Although psychological factors have been suggested to modify therapeutic effects, specifically the implications of attachment styles and the patient-therapist relationship have not been examined in detail yet.MethodsThis study included 44 obese patients who participated in a one-year multimodal weight-reduction program. Attachment style was analyzed by the Adult Attachment Prototype Rating (AAPR) inventory and its relation to a one-year weight reduction program was studied. The patient-therapist-relationship was assessed using the Helping Alliance Questionnaire.ResultsAttachment style was secure in 68% of participants and insecure (preoccupied and dismissing) in 32%. Interestingly a significantly higher weight-reduction was found in securely (SAI) compared to insecurely attached individuals (UAI; p < 0.05). This estimation correlated positively also to the quality of helping alliance (p = 0.004).ConclusionsThe frequency of insecure attachment in obese individuals was comparable to that of the normal population. Our data suggest a greater weight-reduction for SAI than for UAI, and the patient-therapist relationship was rated more positively. The conclusion can be drawn that a patient's attachment style plays a role in an interdisciplinary treatment program for obesity and has an influence on the effort to lose weight.

Changes of attachment status among women with personality disorders undergoing inpatient treatment

AbstractBackground: Attachment has increasingly received attention in psychotherapy and has been used as a predictor of process and outcome. Studies investigating changes of attachment styles during psychotherapy are very rare. Method: Forty women with either borderline (BPD) or avoidant personality disorders (AVPD), treated as inpatients, were investigated using an attachment interview (interpersonal relations assessment (IRA)), and questionnaires to determine therapy outcome at the beginning and after seven weeks of therapy. The IRA uses similar questions as the adult attachment interview (AAI) and is used as the basis for the adult attachment prototype rating (AAPR), a procedure to assign individuals to prototypical categories of attachment. Results: The study showed that the therapy in general was effective. In contrast to other studies, we did not find many women classified as secure at the end of their therapy. Comparisons of pre‐post‐ratings revealed instead that clients within both subgroups received higher ratings for the avoidant prototypes at the end of therapy, indicating deactivation of attachment. Changes from ambivalent to avoidant attachment were linked with better outcome among women with borderline personality disorder (BPD). Conclusions: This study adds further evidence to the result that attachment styles do not change dramatically during a time‐limited psychological treatment of personality disorder. Instead, the study showed that features of preoccupied/ambivalent attachment were less significant after seven weeks of therapy. For women with BPD, these changes were linked with a more favourable outcome which might reflect a more structured and deactivated attachment status as a result of inpatient therapy.

Adult Attachment Styles and Psychological Disease: Examining the Mediating Role of Personality Traits

ABSTRACT The aim of the present study was to examine differences in anxiety and depression related to differences in attachment models of the self and of others and whether personality traits mediate this relationship. The authors assessed attachment styles, anxiety, depression, and personality traits among 274 adult volunteers. Participants were classified into 4 attachment groups (secure, preoccupied, fearful, and dismissing–avoidant) according to K. Bartholomew's (1990) model. The present authors found significant differences among attachment groups on anxiety and depressive symptoms with attachment styles involving a negative self-model showing higher scores than attachment styles characterized by a positive self-model. The authors also found that differences between attachment styles in anxiety and depression remained significant when personality factors related to attachment prototypes were entered as covariates. Results indicate that secure attachment in adults was associated with better mental health, while insecure attachment styles characterized by negative thinking about the self were associated with higher depression and anxiety scores. Our findings seem to evidence that attachment and personality are only partly overlapping and that attachment cannot be considered as redundant with personality in the explanation of psychological disease.

Associations among attachment characteristics, patients’ assessment of therapeutic factors, and treatment outcome following inpatient psychodynamic group psychotherapy

Within a multisite study, including 289 inpatients from six different hospitals who underwent interpersonal-psychodynamic group psychotherapy, associations among attachment characteristics, therapeutic factors, and treatment outcome were investigated. Attachment characteristics were assessed with an interview-based measure (Adult Attachment Prototype Rating [AAPR]) as well as an attachment self-report (Bielefeld Questionnaire of Client Expectations [BQCE]). Therapeutic factors were measured retrospectively with the Düsseldorf Therapeutic Factors Questionnaire and treated as an individual- as well as a hospital-specific characteristic. On an individual level, only the group climate factor independently predicted treatment outcome (i.e., Symptom Checklist-90-R Global Severity Index and Inventory of Interpersonal Problems mean). If simultaneously but separately included into a path model, analyses revealed independent significant effects of AAPR-Security and BQCE-Security on group climate. If modeled as a latent variable (common attachment security), a substantially higher proportion of group climate variance could be explained. Further analyses revealed interactions between particular therapeutic factors and attachment characteristics, indicating a particular importance of these therapeutic factors for different attachment categories.